New mental health screening tool offers hope for asylum seekers and refugees

What started out as an idea nine years ago, has now become a reality for two healthcare workers who are changing the lives of thousands of asylum seekers and refugees across the globe.

Monash University and Cabrini Outreach Psychiatrist, Professor Suresh Sundram and research fellow and clinical psychologist, Dr Debbie Hocking have developed a new tool to screen for mental health disorders in asylum seekers and refugees.

The STAR-MH (Screening Tool for Asylum-seeker and Refugee Mental Health) is a simple mental health screening tool developed for non-mental health trained workers to help identify post-traumatic stress disorder (PTSD) and major depressive disorder in their asylum-seeking and new refugee clients.

The tool, now available around the world and in 13 languages, is for use by workers who come into contact with asylum seekers and refugees upon their arrival, including case workers, welfare workers, nurses, social workers, lawyers, bicultural workers, English language teachers, employment officers and housing workers.

Prof Sundram and Dr Hocking said it was while undertaking other research they found a gap for a screening tool, which could be used by non-mental health trained workers.

“We wanted to identify asylum seekers and refugees who are in need of mental health treatment at the port or agency of presentation,” Dr Hocking said.

STAR MH TNResearch fellow and clinical psychologist, Dr Debbie Hocking and Monash University and Cabrini Outreach Psychiatrist, Professor Suresh Sundram

“Those using this tool may be people like customs officers, border force officers or lawyers – it’s not specific to the health setting.”

Dr Hocking said they discovered there was poor mental health due to the number of rejections or denials in the refugee determination process, and that there were a large proportion who met the criteria for PTSD or major depressive disorders.

“The majority of those were not engaged in treatment,” she said.

“It got us thinking about how and why that was happening.”

The pair then started an informal consultation around Australia and internationally to see if there was a screening tool that already existed.

“We found there were a few tools that were being used but in an ad hoc fashion. We started putting together what we had found and we came up with some criteria we felt were required. This included that it had to be specifically designed for non-mental health trained workers, psychometrically sensitive, and brief and easy to use,” Dr Hocking said.

Prof Sundram said refugees and asylum seekers were often so preoccupied with practical issues like living, food, work and school, that they didn’t have time to think about their health.

“And the workers they interact with are also preoccupied with those issues, so mental illness is not well identified,” he said.

“These people are unwell but no one is recognising they are sick.

“We wanted to capture people rather than let them fall through the gap. What we want is for this tool to be adopted widely, globally, and be used in a range of asylum seeker and refugee organisations around the world.”

Prof Sundram said while undertaking research they had found that, on average, 30 per cent of asylum seekers and refugees suffered from PTSD and 40-50 per cent had a major depressive disorder.

“Our hope is to address the clinical gap for those who need treatment, so they can be identified as early as possible and then access treatment,” Dr Hocking said.

Prof Sundram added that all agencies had a standard physical health protocol for asylum seekers and refugees and it was his hope the STAR-MH would soon be included.

“It’s a great step, a major achievement on the path to have got to that point. It’s easily accessible across the globe,” he said.

“Now we want people to test it, use it and provide feedback and we can modify it as necessary.”

For more information on STAR-MH, go to